Healthcare Provider Details

I. General information

NPI: 1245917087
Provider Name (Legal Business Name): BALANCED PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 S STEMMONS FWY STE 100
LEWISVILLE TX
75067-5351
US

IV. Provider business mailing address

1301 JUSTIN RD STE 201
LEWISVILLE TX
75077-2183
US

V. Phone/Fax

Practice location:
  • Phone: 713-516-3849
  • Fax:
Mailing address:
  • Phone: 713-516-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN MUTHEGA
Title or Position: CEO
Credential:
Phone: 171-351-6384